1、老年医学的误区老年医学的误区欧盟老年病医生培训欧盟老年病医生培训2007年7月美国医学会(AAMC)和 John A.Hartford Foundation 确认老年病医生掌握老年医学知识最低标准:INTERNATIONAL TRAINING PROGRAMME IN MEDICAL GERONTOLOGY老年病培训内容老年病培训内容(联合国老年研究所联合国老年研究所)INIAs 2010 Training Programmesn1526 FebruaryInternational Programme in Social Gerontology.n0819 MarchInternational
2、 Programme in Economic and Financial Aspects of Ageing.n1930 AprilInternational Programme in Medical Gerontology(Geriatrics).n1122 OctoberInternational Programme in Policy Formulation,Planning,Implementationand Monitoring of the Madrid International Plan of Action on Ageing.n29 November10 DecemberIn
3、ternational Programme in Demographic Aspects of Population Ageing and itsImplications for Socio-Economic Development,Policies and Plans.nOctober 2010-June 2011International Post-Graduate Diploma/Masters in Gerontology and Geriatrics(European Centre for Gerontology,University of Malta).误区一Heart disea
4、seTrying to deliver care by oneself.30%of 85 years are deaf in at least one earSexual knowledge,attitudes and activity of older people in Taipei,Taiwan听力问题 25-30%不了解老人住院会出现许多潜在问题开车,游泳和驾船时戒酒,戒药Ancoli-Israel S,et al.71-74 years 1%1999;22(Suppl 2):S347-S353.HypertensionAndrogen Deficiency in Aging Male
5、s(ADAM)85%的尿失禁病人是女性(3)不了解非药物治疗疼痛方法的效果和老人的态度Ancoli-Israel S,Roth T.25%of prescription drugs严重视力障碍(差于20/200)75 years =40%没有足够重视运动或身体活动的重要性老年妇女的实际状况是Activities of Daily LivingAlexopolous,G.b)老年评估和治疗Ancoli-Israel S,et al.Hartford Foundation 确认老年病医生掌握老年医学知识最低标准:听力问题 25-30%Nadol,NEJM,1993不同年龄段男女性别差异门诊抑郁症患
6、者费用高于其他患者43%to 52%International Post-Graduate Diploma/Masters in Gerontology and Geriatrics开车,游泳和驾船时戒酒,戒药（Joint Committee on Higher Medical Training，London）85%的尿失禁病人是女性h)老年服务的发展疾病过程Parkinsons diseaseIgnoring the importance of nutritionIgnoring the importance of nutrition能否以年龄决定老年医疗服务模式推荐适宜照料的环境和设施Un
7、ited Nations Population Fund(UNFPA)Depression:Burden误区二 老年病特点误区三老年医学的目的老年病管理老年病管理HomeDead 个案管理个案管理Case management疾病管理疾病管理Disease/care management自我管理自我管理Self-care support/managementLevel 1 （65%）单一慢病患者单一慢病患者Level 2（30%）重病患者重病患者Level 3（5%）多重疾病患者多重疾病患者基础预防基础预防老年病管理老年病管理误区四老年病的特点老年医学原则误区五听觉损害听觉损害Depressi
8、on:CostsAssuming all older people are alike,mistaking chronological age for physiological ageNot being aware of the many potential problems that often develop when an older person is hospitalized保持健壮的骨骼，肌肉和关节Sexual knowledge,attitudes and activity of older people in Taipei,Taiwan营养不良 20%Journal of C
9、linical Nursing Volume 17 Issue 4,Pages 443-450,Published Online:14 Jan 2008Ignoring the importance of nutritiona)基本照料和适宜服务J Am Geriatr Soc.(3)不了解非药物治疗疼痛方法的效果和老人的态度Geriatric Depression Scale性生活与教育水平,低压力和日常活动程度有关Not paying enough attention to the devastating effects of extremes in hot or cold weather
10、Restless Legs多种药物的应用导致病情复杂化和增大新并发症风险尿失禁 30%多种药物的应用导致病情复杂化和增大新并发症风险Assuming all older people are alike,mistaking chronological age for physiological ageNot being aware of the many potential problems that often develop when an older person is hospitalized不同年龄段男女性别差异视觉损害视觉损害误区六老人常见疾病发病率老人常见疾病发病率误区七Fern
11、andez H.Mount Sinai School of MedicineFernandez H.Mount Sinai School of Medicine长期卧床并发症长期卧床并发症Dr.Blooms 老年病人住院的十条诫律Bloom P.Mount Sinai School of MedicineBloom P.Mount Sinai School of MedicineDr.Blooms 老年病人住院的十条诫律误区八老人占有的医疗服务老人占有的医疗服务医源性疾病医源性疾病开车,游泳和驾船时戒酒,戒药International Programme in Medical Gerontol
12、ogy(Geriatrics).85%的尿失禁病人是女性Not being aware of the many potential problems that often develop when an older person is hospitalized推荐适宜照料的环境和设施29 November10 December60%of federal health dollar住院抑郁症患者费用高于其他患者47%to 51%推荐适宜照料的环境和设施Ignoring the importance of nutritionAssuming all older people are alike,m
13、istaking chronological age for physiological age门诊抑郁症患者费用高于其他患者43%to 52%听力问题 25-30%多种药物的应用导致病情复杂化和增大新并发症风险30%of 85 years are deaf in at least one earSexual knowledge,attitudes and activity of older people in Taipei,Taiwan以为卧床休息是老年患者恢复的良好方式Journal of Clinical Nursing Volume 17 Issue 4,Pages 443-450,P
14、ublished Online:14 Jan 2008营养不良 20%步态不稳 8-19%and Monitoring of the Madrid International Plan of Action on Ageing.误区九老人药效改变老人药效改变Pharmacodynamic Alterations药物不良反应与用药数量的关系药物不良反应与用药数量的关系常见药物副作用误区十短期记忆和长期记忆异常25%of prescription drugs65-74 years=24%（Joint Committee on Higher Medical Training，London）死亡照料30
15、%of 85 years are deaf in at least one earAssuming all older people are alike,mistaking chronological age for physiological ageJournal of Clinical Nursing Volume 17 Issue 4,Pages 443-450,Published Online:14 Jan 2008Hypertension4%老人有适应障碍(Blazer et al,1987)营养不良 20%Not recognizing and not properly treat
16、ing depressionSexual knowledge,attitudes and activity of older people in Taipei,TaiwanAllen R,et al.足量的钙(特别是妇女最大独立最小依赖Maximization of independenceMinimization of dependenceJournal of Clinical Nursing Volume 17 Issue 4,Pages 443-450,Published Online:14 Jan 20081930 AprilJournal of Clinical Nursing Vo
17、lume 17 Issue 4,Pages 443-450,Published Online:14 Jan 2008OKeefe ST,et al.b)老年评估和治疗Assuming all older people are alike,mistaking chronological age for physiological age痴呆、抑郁和谵妄DementiaDepressionDeliriumDepression:BurdenDepression:Costs误区十一轻度认知障碍与痴呆诊断标准轻度认知障碍与痴呆诊断标准Mild cognitive impairment(MCI)v.Dem
18、entia Criteria误区十二误区十三误区十四影响疼痛管理的因素影响疼痛管理的因素误区十五Sexual knowledge,attitudes and activity of older people in Taipei,Taiwan Journal of Clinical Nursing Volume 17 Issue 4,Pages 443-450,Published Online:14 Jan 2008Being unaware of abuse of older individuals by family and others:physical,emotional,economi
19、c,and socialIgnoring the importance of nutrition痴呆病人照料者比其他照料者:Activities of Daily LivingMoss Vital Health Stat,1986.Not paying enough attention to the devastating effects of extremes in hot or cold weather开车,游泳和驾船时戒酒,戒药4th 15th May 2009促进功能改善，提高生存质量a)基本照料和适宜服务OKeefe ST,et al.尿失禁 30%Arch Gen Psychiat
20、ry 2003 60:897-903Performance Orientated Assessment of Mobility没察觉家庭的、肉体的、情感的、经济的和社会方面对老人的虐待不同的文化背景、宗教信仰、社会、子女的极度关注Fernandez H.Assuming that sleep problems are a normal part of aging4th 15th May 2009门诊抑郁症患者费用高于其他患者43%to 52%75 years =40%Peptic ulcer误区十六误区十七Ancoli-Israel S,Roth T.SLEEP.1999;22(Suppl 2
21、):S347-S353.Ancoli-Israel.SLEEP.2000;23:S23-S30.Ancoli-Israel S,Cooke JR.J Am Geriatr Soc.2005;53:S264-271.老人睡眠障碍的影响老人睡眠障碍的影响原发睡眠疾病发病率原发睡眠疾病发病率 疾 病 成人 老人 睡眠呼吸暂停 1%-8%24%-40%周期性肢体运动 5%30%-45%不宁腿综合征 2%-15%12%-30%Young T,Ancoli-Israel S,et al.SLEEP.2001.Mant E,et al.Age and Ageing.1992.Ancoli-Israel S,
22、et al.SLEEP.1993.Phillips BA,et al.SLEEP.1994.Hoch CC,et.al.SLEEP.1994.OKeefe ST,et al.Age and Ageing.1994.Phillips B,et al.Arch Int Med.2000.Allen R,et al.Arch Int Med.2005.误区十八美國預防服務工作小組（美國預防服務工作小組（USPSTF）:65+老人干预老人干预摄用物质摄用物质 戒烟 开车,游泳和驾船时戒酒,戒药运动和饮食运动和饮食 控制脂肪和胆固醇;保持热量平衡;保证谷物,蔬菜和水果 足量的钙(特别是妇女 定期运动美國
23、預防服務工作小組（美國預防服務工作小組（USPSTF）:65+老人干预老人干预(contd)预防损伤预防损伤 膝盖肩膀护带 摩托自行车头盔 防跌倒 烟感器 设置热水器低于50C 家庭成员进行心肺复苏训练口腔卫生口腔卫生 定期看口腔医生 含氟牙膏性行为性行为 预防性传染疾病营养不良 20%伴有智能障碍、肢体活动障碍、抑郁症、营养不良、慢性肝肾功能障碍、骨质疏松、慢性疼痛、大小便失禁和褥疮等综合症Conditions Associated With Sleep Disturbances in the Elderly护理院:12-16%之间(Weissman et al,1991).没有足够重视运动
24、或身体活动的重要性Ancoli-Israel S,et al.Age and Ageing.9)/每年(range:1120).开车,游泳和驾船时戒酒,戒药多种药物的应用导致病情复杂化和增大新并发症风险多种药物的应用导致病情复杂化和增大新并发症风险最大独立最小依赖Maximization of independenceMinimization of dependence71-74 years 1%Not paying enough attention to the devastating effects of extremes in hot or cold weather短期记忆和长期记忆异常
25、Alexopolous,G.（Joint Committee on Higher Medical Training，London）Moss Vital Health Stat,1986.Restless LegsAndrogen Deficiency in Aging Males(ADAM)Fernandez H.Psychiatric disorders误区十九老年综合评估老年人全面评估的目的老年人全面评估的目的Table.Screening Tools for Geriatric Assessment Table.Screening Tools for Geriatric Assessme
26、nt 最大独立最大独立最小依赖最小依赖Maximization of independenceMinimization of dependence误区二十活动方式：活动方式：有氧运动加速心跳和呼吸，有益于心血管功能。有氧运动加速心跳和呼吸，有益于心血管功能。强度和柔韧性运动可保持强壮的骨骼和肌肉强度和柔韧性运动可保持强壮的骨骼和肌肉。规律活动的益处：规律活动的益处：增强体能增强体能保持健壮的骨骼，肌肉和关节保持健壮的骨骼，肌肉和关节增加肌肉的耐力和强度增加肌肉的耐力和强度控制体重控制体重减少心血管病，结肠癌和糖尿病的危险因素减少心血管病，结肠癌和糖尿病的危险因素控制血压控制血压促进心理健康和自
27、信心促进心理健康和自信心减少压抑和忧郁减少压抑和忧郁误区二十一Parkinsons diseaseAncoli-Israel S,et al.老年病房常用评估量表，包括日常生活活动量表、简易智能状态测验、老年人精神忧郁量表，跌倒评估表、吞咽困难及营养评估表等。Level 2（30%）Alzheimers DiseaseFernandez H.29 November10 December门诊抑郁症患者费用高于其他患者43%to 52%Allen R,et al.Being unaware of abuse of older individuals by family and others:phy
28、sical,emotional,economic,and socialActivities of Daily LivingHypertensionArch Gen Psychiatry 2003 60:897-9034th 15th May 2009Journal of Clinical Nursing Volume 17 Issue 4,Pages 443-450,Published Online:14 Jan 2008Assuming all older people are alike,mistaking chronological age for physiological age不宁
29、腿综合征 2%-15%12%-30%1122 OctoberConditions Associated With Sleep Disturbances in the ElderlyMant E,et al.Mant E,et al.丰富的社会阅历形成特有的价值观和世界观照料者（亲属或护工）的负担照料者（亲属或护工）的负担误区二十二虐待形式和表现n身体上n心理和情绪上n财务上n性n歧视n权利上n自我忽视n沮丧和孤僻n不离开家人或照料者n不亲自作出决定n从不花钱n厌恶看医生n出现太多的家庭意外n对照料者隐瞒事情虐待者可以是任何人老年病特点老年病管理老年病管理HomeDead老年医学原则Fernan
30、dez H.Mount Sinai School of MedicineFernandez H.Mount Sinai School of Medicine美國預防服務工作小組（美國預防服務工作小組（USPSTF）:65+老人干预老人干预摄用物质摄用物质 戒烟 开车,游泳和驾船时戒酒,戒药运动和饮食运动和饮食 控制脂肪和胆固醇;保持热量平衡;保证谷物,蔬菜和水果 足量的钙(特别是妇女 定期运动老年人全面评估的目的老年人全面评估的目的对气候变化没有足够关注Mount Sinai School of MedicineInternational Programme in Social Geronto
31、logy.29 November10 DecemberMant E,et al.Trying to deliver care by oneself.Not adequately emphasizing the importance of exercise or physical activity认知障碍 12%Allen R,et al.Under-diagnosing and inadequately treating painb)老年评估和治疗以为卧床休息是老年患者恢复的良好方式实际年龄、生理年龄与心理年龄强度和柔韧性运动可保持强壮的骨骼和肌肉。Nursing home patients19%Phillips B,et al.促进功能改善，提高生存质量Salive ME Ophthalmology,1999.血栓性静脉炎和血栓栓塞25%of prescription drugsAndrogen Deficiency in Aging Males(ADAM)周期性肢体运动 5%30%-45%
